Like many psychiatrists, I eagerly awaited the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), which corrects problems identified in earlier versions of our diagnostic manual while incorporating recent advances. The DSM-5 task force included leaders in psychiatry who worked for the better part of a decade to review evidence and revise diagnoses and diagnostic criteria. The task force made potential changes in diagnostic criteria available online, sought public comment, and revised the diagnoses again through expert review.1 Afterward, they conducted field trials at academic medical centers to assess reliability. Despite all of this learned effort, the interrater reliability of one of the most common mental disorders, major depressive disorder, remains discouragingly low, with a κ of 0.28 in both adults and children indicating only “questionable agreement” between two mental health clinicians evaluating the same person for depression.2 Because most diagnoses of major depressive disorder occur in community settings, where the criteria are presumably applied less rigorously, what are we saying when we diagnose a person with major depressive disorder? More broadly, what does this say about what goes on when we physicians directly examine a patient?
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.